Last updated: 19-Oct-2026
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Urology Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ 4.99 from 84 Google reviews (Gota clinic) · 5.0 from 37 (Apollo, Bhat)
IN SHORT
A tumour held inside the ureter or the kidney’s drainage lining is treated in one of two ways. Either the kidney is kept, or the kidney and the whole ureter are removed.
Low risk means all five together: one tumour, under two centimetres, low-grade urine cells, a low-grade biopsy, and no invasive look on the scan.
Keeping the kidney is not a smaller operation. It commits you to a second camera check within eight weeks, and then to checks that never stop.
This page is one part of a larger guide. For how ureter and renal pelvis cancer is treated and why the whole ureter is removed, start with our nephroureterectomy guide. For the wider picture of kidney cancer surgery, see our kidney cancer surgery guide.
For a cancer that has not spread, the plan turns on one question. Can this tumour be cleared while the kidney stays in place?
The answer is not a matter of taste. It follows the risk group, the site of the tumour, and how well the two kidneys work. It is agreed at a meeting of the treating doctors before treatment starts, never on the day of surgery.
| Route | Who it is offered to | What it asks of you |
|---|---|---|
| Kidney-sparing treatment. | Low-risk tumours. Also anyone for whom losing the kidney would mean dialysis. | Repeated camera tests under anaesthesia, for life. |
| Removing the kidney with the whole ureter. | High-risk tumours, where the kidney on the other side is sound. | Life with one kidney, and bladder checks for life. |
All five must hold. One tick missing moves the tumour to the other group.
Any one of these puts the tumour in the high-risk group: more than one tumour, a size of two centimetres or more, high-grade urine cells, a high-grade biopsy, an invasive look on the scan, a swollen kidney above the tumour, an unusual tissue type, or an earlier bladder removal for high-grade bladder cancer.
The grade has to be known before the kidney can be kept. That is why a camera test with a biopsy is needed first whenever kidney-sparing treatment is being considered.
The reverse also holds. Where the scan and high-grade urine cells already settle the plan, that camera test is left out. It would add risk and change nothing.
Keeping the kidney is not one operation. It is four, and the site of the tumour chooses between them.
| Site of the tumour | What is done | Point to know |
|---|---|---|
| Inside the kidney’s drainage space, or the upper ureter. | A laser passed up through a thin camera burns the tumour away. | No cut on the skin. No tissue is left to report on. |
| The lower ureter, close to the bladder. | That length of ureter is removed and the cut end is joined into the bladder. | Gives a full tissue report, so it is the choice for tumours here. |
| The middle of the ureter. | The affected segment is cut out and the two ends are joined. | The kidney stays, and the tissue is examined. |
| A bulky tumour low in the drainage space. | Treatment through a small tunnel made in the back. | Cancer cells can seed along the tunnel. This is said before you agree. |
A medicine can also be run into the upper urinary tract through a fine tube. Mitomycin gel is one choice. BCG is used for a flat early form, where supply allows. The proof behind both is modest, so they are added to the checks and never put in their place.
For a high-risk tumour, the kidney, the whole ureter and a cuff of the bladder are taken out in one piece. The page on radical nephroureterectomy explains the operation itself and why none of the ureter may be left behind.
Three decisions sit inside that operation.
Timing matters. From the day the diagnosis is settled, the operation is not pushed beyond about twelve weeks.
The drainage lining and the bladder behave as one surface. So one wash of chemotherapy is put into the bladder within ten days of the operation, once the bladder closure is shown to be sound. It lowers the chance of a new tumour in the bladder. It is cheap, it is backed by trials, and it is the step most often forgotten.
The same wash is given after a camera treatment of the upper tract.
Your kidney function is written down as a number before surgery, not after. It falls once a kidney is removed and stays lower. That one number decides whether the stronger chemotherapy drug can ever be used.
If the tissue report shows the tumour reached the muscle or beyond, or that glands were involved, chemotherapy after surgery is advised. It has to start within ninety days. Many people who could have had the stronger drug before the operation can no longer have it afterwards, so the cancer physician is given the number and is seen before you go home.
Where the risk is high and kidney function is borderline, chemotherapy before surgery is sometimes discussed. For this cancer it is a case-by-case choice, not a proven path.
Both routes end in surveillance, but not the same surveillance.
| After which route | First year | Later |
|---|---|---|
| Kidney-sparing treatment. | A second camera test within eight weeks. Then bladder and ureter camera tests, a CT urogram and urine cells at three and six months. | Six-monthly for two years, then yearly, for life. |
| Removal, high-risk tissue report. | Bladder camera test and urine cells every three months. A CT scan with urography every six months. | Six-monthly to five years, then yearly, for life. |
| Removal, low-risk tissue report. | Bladder camera test and urine cells at three and nine months. | Yearly, with a yearly scan, for life. |
Blood in the urine at any point in follow-up means a bladder camera test within two weeks. Stopping smoking belongs in the treatment, not beside it, because smoking drives the cancer back into the bladder.
Often it can, when the tumour is low risk, or when removing the kidney would mean dialysis. Where in the ureter it sits decides the method.
One tumour, smaller than two centimetres, low-grade urine cells, a low-grade biopsy, and no invasive look on the CT urogram. All five are needed.
Laser treatment leaves no tissue to report on. A second look within eight weeks shows whether anything was left behind, and is part of the treatment.
One wash of chemotherapy in the bladder, within ten days, lowers the chance of a new tumour there. It is given once the bladder is sealed.
Yes. In some people the cancer returns in the kept kidney, and the full operation is then advised. That is said plainly before you choose.
The operation that removes the kidney and the whole ureter is set out on the radical nephroureterectomy page. The signs that bring people in, and the first tests, are on the ureter and renal pelvis cancer signs page. To talk through your own reports, call +91-63590-11009. Gota OPD, Gota, Ahmedabad.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Urology Cancer Surgeon
Consultation: Gota OPD, Gota, Ahmedabad. Surgery: Apollo Hospital, Bhat, Gandhinagar.
Gota OPD — Gota, Ahmedabad, Gujarat
Apollo Hospital, Bhat, Gandhinagar — Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar, Gujarat
Call: +91-63590-11009 · WhatsApp: +91-63590-11009
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